Key takeaways:
- Among those with COPD who lived with a loved one, nearly 20% reported inadequate social support.
- Inadequate vs. adequate social support contributed to poorer clinical outcomes.
Perceived inadequate social support among patients with COPD living with a loved one was linked to more depression symptoms and greater disease impact, according to results published in Respiratory Medicine.
“This study underlines the importance of addressing social support in the care for patients with COPD, even if they have a resident loved one,” Anna L. Stoustrup, PT, MSc, PhD fellow at Aalborg University Hospital in Denmark, and colleagues wrote.
In a cross-sectional study, Stoustrup and colleagues assessed 191 patients with COPD (mean age, 65.6 years; 53.4% men; mean FEV1 47.3% percent predicted) living with a loved one to determine how inadequate vs. adequate social support impacts eight clinical outcomes: lung function, dyspnea, health status, anxiety symptoms, depression symptoms, care dependency, functional status and mobility.
Researchers used the Medical Outcomes Study-Social Support Survey (MOS-SSS) to find out if patients perceived their social support as adequate or inadequate.
The most common relationship patients had with their resident loved one was spouse/partner (97.9%), with fewer patients living with their child (1.6%) or friend (0.5%).
Of the total cohort, more patients reported adequate vs. inadequate social support (81.7% vs. 18.3%). In the adequate social support group, the average overall support index score was 4.5 out of 5 points, whereas this score was 2.8 out of 5 points in the inadequate social support group.
Three of the eight assessed clinical outcomes significantly differed according to the level of perceived social support, with worse outcomes seen in the inadequate group, researchers wrote.
Use of the COPD Test Assessment revealed a higher disease impact among patients with inadequate vs. adequate social support (25 points vs. 21 points; P = .004).
To evaluate symptoms of depression and anxiety, researchers used the Hospital Anxiety and Depression Scale (HADS) and found scores signaling more depression symptoms in the group with perceived inadequate social support (8 points vs. 5 points; P = .004).
Lastly, inadequate social support was linked to an elevated Care Dependency Scale score, suggesting more care dependency, when compared with adequate social support (69 points vs. 71 points; P = .04) in this study population.
Lung function (FEV1 percent predicted), dyspnea (Modified Medical Research Council Dyspnea Scale score), anxiety symptoms (HADS-anxiety score), functional status (Instrumental Activity of Daily Living score) and mobility (Timed Up and Go test) did not significantly differ based on inadequate vs. adequate social support.
“The relationship between perceived level of social support and actual support needs is relevant to unravel further when using the MOS-SSS or otherwise assessing social support among patients with COPD,” Stoustrup and colleagues wrote.
Perspective
Health professionals often assume that patients with COPD who are living with a spouse or other loved one are getting the support they need at home. Yet Stoustrup’s study indicates that is not the case for one-fifth of patients with COPD. Furthermore, patients with inadequate support have worse COPD symptoms, higher care dependency needs and more depressive symptoms than their peers who have adequate support from loved ones.
The results of Stoustrup’s study from the Netherlands indicating a strong link between inadequate social support and depression among those with COPD is in keeping with my own research. In an article published last year, we studied more than 500 Canadians with COPD with no pre-pandemic history of depression and found that those who were lonely had more than triple the odds of developing depression during the pandemic. In a nationally representative study of 700 older Canadians with COPD that was published in 2022, we found that those with at least one confidant had seven times the odds of being in excellent mental health compared with those who had no confidant.
These findings underline the need for doctors and other medical professionals to assess the social support available for all their patients including those living alone and those living with others. Without consistent screening for inadequate support, it is not possible to provide targeted interventions to those who need it. Cognitive behavioral therapy is an effective and well-researched intervention to address mental health problems and quality of life among those with COPD.
Future research is essential to identify successful interventions to foster social support and address loneliness and inadequate support among those with COPD. One promising intervention that deserves further study is “social prescribing” where doctors formally refer patients to nonclinical community-based programs such as an art class, a support group or a community garden group to help address some of their social support needs.
Esme Fuller-Thomson, PhD, MSW
Director, Institute for Life Course and Aging, University of Toronto
Professor, Factor-Inwentash Faculty of Social Work, University of Toronto
Disclosures: Fuller-Thomson reports no relevant financial disclosures.